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Jennifer is 48 and perimenopausal. She’s content with her sex life, but lately she’s noticed that she needs to put some priority on sex during her busy day and find ways to boost her libido. She’s scared.

‘The day I can’t make love is the day I want to die,’ she said. Are her worries legitimate?

Dr. Stephen Holzapfel feels it’s important to remember that we are sexual beings.

‘Even when we stop having intercourse, we still have sexuality,’ said Holzapfel, director of the Sexual Medicine Counselling Unit at Women's College Hospital, and author of Aging and Sexuality.

‘However, as people age — things change.’

Because women go through menopause, changes are more apparent. Estrogen levels drop by about 80 per cent and testosterone by about half. The estrogen drop can lead to thinner vaginal walls and less vaginal lubrication.

Less testosterone — the ‘desire hormone’ — can cause lower libido. Psychologically, no longer being able to conceive can feel like a loss to some women, while it can be liberating for others.

Half of men 40 to 70 have some sexual dysfunction. Among 40-year-olds, the rate of erectile difficulties is five percent. By age 70, that rate has risen to 15 percent. While women’s sexual desire can decline rapidly, for men it is more gradual. Older men with new partners can suddenly find they can't get an erection.

Peter is 70. His sex life has changed drastically since his health declined. ‘Sometimes I want to get closer than cuddles but sadly am unable to do so. Not being able to sustain an erection anymore can be frustrating. Instead of the early morning sex I enjoyed as a young man, now I just want to lie in bed until 8 a.m.’

There are simple tests for erectile dysfunction, and drugs like Viagra may be the answer for some men. The introduction of such drugs has allowed men and women to speak more openly to their doctors about their sex lives. Similar miracles have not evolved for women — although testosterone therapy shows promise for women who have their ovaries removed.


The media’s influence

The media plays a big role in how we view ourselves. ‘Sometimes I can feel a little oppressed by the pressure to perform,’ says Maureen, 57. ‘I think drugs like Viagra put too much emphasis on the erection and puts foreplay into a poor supporting role.’

Holzapfel stresses sexuality is an individual thing. ‘Each couple decides how much they are going to be sexual. Even if they are not having sex or it’s infrequent or not as intense, they can still enjoy being sexual.’

If they are sexually active, the older couple may find advantages. Both men and women take longer to reach orgasm. Without the fear of pregnancy, no interruptions from work and children, and with a deeper understanding of each other, sex can be an unhurried and pleasurable event.


Health problems a prime issue

The biggest factor in sexuality as we age is health. We may feel unwell or be in pain, and the drugs we take for conditions like high blood pressure, depression and diabetes all affect libido.

Brenda is 70. She says, ‘We have not had sex in over six years now, mostly because of side effects of medications.’

Edna is 65 and remembers the multiple orgasms she had as a younger woman. She is saddened by her inability to reach orgasm these days and blames her antidepressants.

Pamela is 71 and still quite an athlete. She reports that, despite some decrease in desire and lubrication, ‘I still have the same great orgasms I had as a young woman and I imagine we will continue to have sex, but at a much reduced level.’

By age 80, 25 percent of the population has some degree of dementia. Although this does not diminish sexual desire, it sends many people to nursing homes where they are desexualized and segregated.

‘When we allow the healthy partner to live with the unhealthy partner, both will live longer with a healthier quality of life, and this reinforces the idea that the need for closeness never goes away,’ Holzapfel said.


Communication is key

Brenda knows that intimacy does not need to be in the form of intercourse.

‘Sex is just one way of communicating with one another. We walk hand in hand, and we hug and kiss. The important thing is to be able to talk to each other and our lives and our love are so much richer because of this. We are now the best of friends.’

Edna agrees. ‘We still have sex but it is not the same thing at all. Now it's enjoying the closeness.’

Maureen’s declining interest in sex coincided with diminished lubrication, which made intercourse painful.

Eventually her partner, several years her junior, stopped wanting sex with her and is now with a woman closer to his age. Maureen feels she is unlikely to find anyone who wants just friendship. ‘I am quite happy with sex for one,’ she says.

There are solutions for those couples whose sex life has diminished but who want to do something about it. Many women find hormone replacement therapy (HRT) helpful.

Women's sexuality after menopause is quite closely related to their sexuality before menopause. Because regular sexual intercourse prevents atrophy in the vagina, the expression ‘Use it or lose it’ has a basis in truth.

Holzapfel recommends lubricants (such as Astroglide), medication where appropriate and different sexual positions (if suffering from joint pain).

‘Not everything can be cured with a pill — there may be relationship issues or family concerns that contribute to sexual dysfunction,’ he said.

‘Whatever your age, communication is the most important sexual aid. People need to feel comfortable talking to their doctor…to hear they are OK, whether or not they are having sex,’ Holzapfel continued.

‘Sexuality is not an off/on switch. It’s a dimmer switch that each couple needs to set at the right level for them — it might not be set as bright as it once was, but can still provide a warm intimate glow.’ Jump to top page